Tag: communication

“The great divisions among humankind and the dominating source of conflict will be cultural. Nation states will remain the most powerful actors in world affairs, but the principal conflicts of global politics will occur between nations and groups of different civilizations. The clash of civilizations will dominate global politics.”

—Samuel P. Huntington (1972-2008) “The Clash of Civilizations“

In 1993, the Harvard political scientist Samuel Huntington published his now infamous paper The Clash of Civilizations in the journal Foreign Affairs. Huntington hypothesized that conflicts in the post-Cold War era would occur between civilizations or cultures and not between ideologies. He divided the world into eight key civilizations which reflected common cultural and religious heritages: Western, Confucian (also referred to as “Sinic”), Japanese, Islamic, Hindu, Slavic-Orthodox, Latin-American and African. In his subsequent book “The Clash of Civilizations and the Remaking of the World Order“, which presented a more detailed account of his ideas and how these divisions would fuel future conflicts, Huntington also included the Buddhist civilization as an additional entity. Huntington’s idea of grouping the world in civilizational blocs has been heavily criticized for being overly simplistic and ignoring the diversity that exists within each “civilization”. For example, the countries of Western Europe, the United States, Canada and Australia were all grouped together under “Western Civilization” whereas Turkey, Iran, Pakistan, Bangladesh and the Gulf states were all grouped as “Islamic Civilization” despite the fact that the member countries within these civilizations exhibited profound differences in terms of their cultures, languages, social structures and political systems. On the other hand, China’s emergence as a world power that will likely challenge the economic dominance of Western Europe and the United States, lends credence to a looming economic and political clash between the “Western” and “Confucian” civilizations. The Afghanistan war and the Iraq war between military coalitions from the “Western Civilization” and nations ascribed to the “Islamic Civilization” both occurred long after Huntington’s predictions were made and are used by some as examples of the hypothesized clash of civilizations.

It is difficult to assess the validity of Huntington’s ideas because they refer to abstract notions of cultural and civilizational identities of nations and societies without providing any clear evidence on the individual level. Do political and economic treaties between the governments of countries – such as the European Union – mean that individuals in these countries share a common cultural identity?

Also, the concept of civilizational blocs was developed before the dramatic increase in the usage of the internet and social media which now facilitate unprecedented opportunities for individuals belonging to distinct “civilizations” to interact with each other. One could therefore surmise that civilizational blocs might have become relics of the past in a new culture of global connectivity. A team of researchers from Stanford University, Cornell University and Yahoo recently decided to evaluate the “connectedness” of the hypothesized Huntington civilizations in cyberspace and published their results in the article “The Mesh of Civilizations in the Global Network of Digital Communication“.

The researchers examined Twitter users and the exchange of emails between Yahoo-Mail users in 90 countries with a minimum population of five million. In total, they analyzed “hundreds of millions of anonymized email and Twitter communications among tens of millions of worldwide users to map global patterns of transnational interpersonal communication”. Twitter data is public and freely available for researchers to analyze whereas emails had to be de-identified for the analysis. The researchers did not have any access to the content of the emails, they only analyzed whether users any given country were emailing users in other countries. The researchers focused on bi-directional ties. This means that ties between Twitter user A and B were only counted as a “bi-directional” tie or link if A followed B and B followed A on Twitter. Similarly, for the analysis of emails analysis, the researchers only considered email ties in which user X emailed user Y, and there was at least one email showing that user Y had also emailed user X. This requirement for bi-directionality was necessary to exclude spam tweets or emails in which one user may send out large numbers of messages to thousands of users without there being any true “tie” or “link” between the users that would suggest an active dialogue or communication.

Credit: State et al, PloS ONE 2015; Countries are clustered based on the difference between observed and expected density of social ties in 90 countries with population above 5 million, based on interpersonal email and Twitter communication.

The researchers then created a cluster graph which is shown in the accompanying figure. Each circle represents a country and the 1000 strongest ties between countries are shown. The closer a circle is to another circle, the more email and Twitter links exist between individuals residing in the two countries. For the mathematical analysis to be unbiased, the researchers did not assign any countries to “civilizations” but they did observe key clusters of countries emerge which were very close to each other in the graph. They then colored in the circles with colors to reflect the civilization category as defined by Huntington and also colored ties within a civilization as the same color whereas ties between countries of two distinct civilization categories were kept in gray.

At first glance, these data may appear as a strong validation of the Huntington hypothesis because the circles of any given color (i.e. a Huntington civilization category) are overall far closer to each other on average that circles of a different color. For example, countries belonging to the “Latin American Civilization” (pink) countries strongly cluster together and some countries such as Chile (CL) and Peru (PE) have nearly exclusive intra-civilizational ties (pink). Some of the “Slavic-Orthodox Civilization” (brown) show strong intra-civilizational ties but Greece (GR), Bulgaria (BG) and Romania (RO) are much closer to Western European countries than other Slavic-Orthodox countries, likely because these three countries are part of the European Union and have shared a significant cultural heritage with what Huntington considers the “Western Civilization”. “Islamic Civilization” (green) countries also cluster together but they are far more spread out. Pakistan (PK) and Bangladesh (BD) are far closer to each other and to India (IN), which belongs to the “Hindu Civilization” (purple) than to Tunisia (TN) and Yemen (YE) which Huntington also assigned to an ‘Islamic Civilization”.

One obvious explanation for there being increased email and Twitter exchanges between individuals belonging to the same civilization is the presence of a shared language. The researchers therefore analyzed the data by correcting for language and found that even though language did contribute to Twitter and email ties, the clustering according to civilization was present even when taking language into account. Interestingly, of the various factors that could account for the connectedness between users, it appeared that religion (as defined by the World Religion Database) was one of the major factors, consistent with Huntington’s focus on religion as a defining characteristic of a civilization. The researchers conclude that “contrary to the borderless portrayal of cyberspace, online social interactions do not appear to have erased the fault lines Huntington proposed over a decade before the emergence of social media.” But they disagree with Huntington in that closeness of countries belonging to a civilization does not necessarily imply that it will lead to conflicts or clashes with other civilizations.

It is important to not over-interpret one study on Twitter and Email links and make inferences about broader cultural or civilizational identities just because individuals in two countries follow each other on Twitter or write each other emails. The study did not investigate cultural identities of individuals and some of the emails could have been exchanged as part of online purchases without indicating any other personal ties. However, the data presented by the researchers does reveal some fascinating new insights about digital connectivity that are not discussed in much depth by the researchers. China (CN) and Great Britain (GB) emerge as some of the most highly connected countries at the center of the connectivity map with strong global ties, including India and countries in Africa. Whether this connectivity reflects the economic growth and increasing global relevance of China or a digital footprint of the British Empire even decades after its demise would be a worthy topic of investigation. The public availability of Twitter data makes it a perfect tool to analyze the content of Twitter communications and thus define how social media is used to engage in dialogue between individuals across cultural, religious and political boundaries by analyzing culturally relevant keywords used in tweets. Analyses of Twitter data over time could test the intriguing hypothesis whether connectivity and the content of communications between users living in different countries change over time. Such a study would be even more informative in terms of linking cyberspace connectivity to cultural identities and could provide insights into the evolution of digital ties over time.

Each year in the United States about 720,000 people have heart attacks and about 124,000 people in the UK and 55,000 people in Australia will have them as well. Since the 1980s, survival rates from heart attacks have improved – a lot of people get them, but more and more people are surviving. A recent study of patients in Denmark showed that in 1984-1988 31.4% of patients died within a month of having a heart attack. From 2004-2008 this was down to 14.8%.

Once a patient has made it through a heart attack and begins to recover, they get advice from their doctors on what to do to stay healthy and get back to normal. That includes a lot of things – when to go back to work, when they can start traveling again and what to eat. But there is an important item that a lot of doctors don’t talk about: sex.

There are no universal guidelines for getting back to ‘normal’

Providing advice about lifestyle can be more challenging than prescribing standardized medications or smoking cessation because “normal” life differs widely among patients and requires individualized counseling.

For instance, scientific evidence from large-scale clinical trials isn’t always available to help the cardiologist decide the ideal time for when an individual patient should return to work. A software engineer might get different advice than a butcher or construction worker who has to lift heavy objects all day long. Physicians have to carefully estimate the patient’s capacity for physical activity as well as the physical demands of the job and be pragmatic about how long a patient can take time off from work.

Sex also requires this kind individualized counseling. New research shows that patients want to talk about sexual activity with their doctors, but that all too often that conversation never takes place.

Let’s talk about sex

A recent study conducted in 127 hospitals in the United States and Spain suggests that doctors are not very good at broaching the topic of sexual activity after a heart attack.

Researchers studied 2,349 women and 1,152 men who had suffered from a myocardial infarction (the medical term for a heart attack). This study focused on younger heart attack patients (ages 18-55) and asked them whether they had discussed sexual activity with their doctors. With younger patients talking about life after a heart attack is especially important. The loss of sexual activity or function is a major quality of life issue, and can affect intimate relationships, reproduction and lead to depression.

In the month following the heart attack, only 12% of women and 19% of men had some discussion with a doctor about sex. In the US, most patients reported that they initiated the discussion, whereas in Spain, most discussions were initiated by the doctor. This means that more than 85% of patients received no advice from their doctors regarding if and when they could resume sexual activity.

The study found that the vast majority of patients were sexually active in the year before their heart attacks, and they valued sexuality as an important part of life. They also felt it was appropriate for physicians to initiate the discussion about having sex again.

It is interesting that in the US, patients were more likely to bring up sex and men were given more restrictive advice, while in Spain, physicians were more likely to bring up the topic and more restrictive recommendations were given to women.

The study did not specifically study the motivations of the physicians but these differences suggest that cultural differences and gender affect the counseling in regards to sexual activity. Future research could potentially also study the physicians and help uncover how culture and gender influence the counseling process.

This lack of communication between doctors and patients was not due to the patients’ unease: 84% of women and 91% of men said that they would feel comfortable talking to their doctors about sex. What is even more concerning is that the 15% or so of patients who received counseling often got inaccurate recommendations.

Sex is exercise. But doctors don’t talk about it that way

Two-thirds of those who talked about sex with their doctors were told that they could resume sexual activity with restrictions like limiting sex, taking a “passive role” or keeping their heart rate down during sex. But here’s the thing: sex is exercise. And after a heart attack doctors routinely ask patients whether they can tolerate mild to moderate physical activity such as mowing the lawn or climbing up two flights of stairs without chest pain or other major symptoms.

The Scientific Statement of the American Heart Association (AHA) on sexual activity states that it is reasonable to resume sexual activity as early as one week after an uncomplicated heart attack. If there are complications after the heart attack such as feeling out of breath or experiencing persistent chest pain then these problems need to be addressed first. And in the AHA guidelines there is no mention of “passive roles” or keeping heart rates down during sex. These restrictions are also quite impractical. How are patients supposed to monitor their heart rates and keep them down during sex?

The kind of restrictions recommended by doctors in the study – and presumably by medical practitioners who weren’t polled – are not backed up by science and place an unnecessary burden on a patient’s personal life. Hopefully, after reading the results of this study, doctors will take a more pro-active role and address the topic of sex with their heart attack patients with proper recommendations instead of leaving patients in a state of uncertainty. If a patient can handle moderate exercise, they can probably handle sex.